Reconsidering Surgical Eligibility in Older Adults With Early-Stage NSCLC

As the population ages, the incidence of lung cancer among older adults continues to rise, particularly for those aged 80 years and older. Historically, older age has been a limiting factor in determining eligibility for surgical intervention in early-stage non–small cell lung cancer (NSCLC). However, a new prospective cohort study published in The Lancet Regional Health Americas provides new data against this view, pointing out that properly selected octogenarians can have surgery outcomes that are comparable to those of younger patients following surgery.^1,2

Comparable Survival Outcomes Across Age Groups

The prospective study enrolled 884 patients with early-stage NSCLC, including 114 aged 80 or older, to assess surgical outcomes and long-term survival. The study data showed that the survival rates of both older and younger groups were nearly equal, indicating that using age alone as a criterion for deciding on surgery may not be reliable.¹

These findings reinforce a growing body of evidence emphasizing physiologic rather than chronologic age in treatment decisions. “Our findings show that when patients are carefully selected based on their overall health, not just their age, they can tolerate surgery well and experience excellent long-term outcomes,” said Raja M. Flores, MD, chair of the Department of Thoracic Surgery at Mount Sinai Health System.²

For pharmacists and multidisciplinary care teams, these results underscore the importance of comprehensive patient assessment, including comorbidities, functional status, and medication optimization, when evaluating treatment options.

Postoperative Complications and Recovery

Although octogenarians experienced slightly higher rates of short-term postoperative complications, these differences did not translate into worse long-term outcomes. Importantly, most complications were manageable, and recovery trajectories were favorable across both age groups.¹

This study emphasizes the importance of thoughtful perioperative care, especially for older adults who are more susceptible to adverse events. Pharmacists are very important in decreasing the postoperative risks through medication reconciliation, monitoring for drug interactions, and promoting symptom management methods.

From a clinical perspective, these research findings contradict the idea that older adults are poor surgical candidates. Instead, they suggest that with appropriate selection and supportive care, surgery remains a viable and potentially curative option.

Improvements in Quality of Life

Aside from survival, quality of life (QoL) is a top priority in oncology treatment and care, especially among older individuals. The data from this study showed that most patients, regardless of age, experienced improved QoL 1 year after surgery.¹

This finding is important considering the concerns that invasive medical procedures may compromise functional independence in older adults. The results indicate that a successful surgical operation can result in meaningful recovery and better QoL.¹

“Our study highlights the importance of making sure all patients are evaluated based on their overall health, not just their age,” said Emanuela Taioli, MD, PhD, director of the Institute for Translational Epidemiology at Icahn School of Medicine at Mount Sinai. “Older adults are often left out of clinical decisions, but our findings show they should have equal access to care that can improve survival and quality of life.”²

The Expanding Role of Pharmacists

Pharmacists offer a unique opportunity to be at the forefront of this changing health care model. Their role could include modifying medication profiles before surgery, addressing additional health issues, and securing a safety-first approach to healing after a surgical procedure. In older adults, careful attention to polypharmacy and age-related pharmacokinetic changes is essential to minimize complications and improve outcomes.

Additionally, pharmacists may take the lead in advancing the justice of health care delivery by participating with other professionals in discussions of the therapeutic plan and challenging stereotyped notions about older adults’ eligibility for treatment.

Conclusion

The results of this prospective cohort study strongly suggest that age alone is not a sufficient reason to deny patients with early-stage NSCLC surgery. When properly selected for surgery and with comprehensive care, octogenarians can achieve survival and QoL results similar to those of younger individuals. As the aging population grows, it will be very important to use individual, evidence-based methods for better cancer treatment among older adults.

REFERENCES

1. Gros L, Yip R, Ma W, et al; iELCART Investigators. Surgical outcomes and quality of life in octogenarians with early-stage non-small cell lung cancer: a prospective cohort study. Lancet Reg Health Am. 2026;56:101428. doi:10.1016/j.lana.2026.101428

2. Mount Sinai study finds lung cancer surgery safe for many patients over 80. Mount Sinai. April 2, 2026. Accessed April 6, 2026. https://www.mountsinai.org/about/newsroom/2026/mount-sinai-study-finds-lung-cancer-surgery-safe-for-many-patients-over-80